Therefore, experts at the Department of Veterans Affairs (VA) Center for Clinical Epidemiology, St. Louis Healthcare System, used the national VA database to create a cohort of people with new PPI use and new H2 receptor antagonist (H2RA) use, followed for more than 5 years, to clarify the impact of PPI use on renal regression. The article was published in the October 2016 issue of JASN.
Research results
1. In a corrected Cox survival model, the risk of EGFR was increased by 60 ml/min/1.73 m2 in the PPI group compared to the H2RA group.The risk of CKD was also increased in the PPI group.
2. Patients treated with PPIs had doubled serum creatinine levels, 30% lower eGFR and a significantly increased risk of entering ESRD compared to the H2RA group. The risk ratio HRs were 1.53, 1.32, and 1.96, respectively.
3. A hierarchical relationship was observed between the duration of PPI exposure and the risk of renal outcomes: patients exposed to PPIs for 31-90, 91-180, 180-360, and 361-720 days had an increased risk of adverse renal outcomes compared with patients exposed to PPIs for 30 days.
4. To validate these results, the researchers performed sensitivity analyses in a 1:1 intention score cohort. Renal outcomes were assessed in patients who had recently taken a PPI and H2RA, as well as in patients who had recently taken a PPI and placebo.
The factors were well balanced in both groups, and the results were consistent with the preliminary analysis: a PPI was associated with poor renal outcomes.
Thus, this study confirms that PPI exposure is associated with the onset and progression of CKD and an increased risk of ESRD.Clinical use of PPI drugs should be monitored for changes in eGFR levels.